Meta-Analysis
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World J Gastroenterol. Nov 14, 2013; 19(42): 7461-7471
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7461
Combined radiochemotherapy in patients with locally advanced pancreatic cancer: A meta-analysis
Yue Chen, Xian-Jun Sun, Ting-Hui Jiang, Ai-Wu Mao
Yue Chen, Department of Radiology, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Xian-Jun Sun, Department of Combined Traditional Chinese and Western Medicine for Liver, Gallbladder and Pancreas Diseases, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China
Ting-Hui Jiang, Ai-Wu Mao, Intervention Center, Tongren Branch, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200050, China
Author contributions: All the authors were involved in the design of the protocol and assessment of the studies identified; Chen Y and Sun XJ performed data entry and analysis; Jiang TH, Mao AW and Chen Y drafted the manuscript; all authors have read and approved the final version to be published.
Supported by Shanghai Science and Technology Development Fund, No. 10JC1412902
Correspondence to: Ai-Wu Mao, MD, Intervention Center, Tongren Branch, Renji Hospital of Shanghai Jiaotong University School of Medicine, No. 786, Yuyuan Road, Shanghai 200050, China. jiangyuewu777@gmail.com
Telephone: +86-21-62524259-3397 Fax: +86-21-62113884
Received: June 2, 2013
Revised: August 8, 2013
Accepted: August 20, 2013
Published online: November 14, 2013
Abstract

AIM: To compare the long-term clinical efficacy of chemotherapy plus radiotherapy (CRT) with that of radiotherapy alone (RT) or chemotherapy alone (CT) for locally advanced pancreatic carcinoma (LAPC).

METHODS: Using manual and computer-aided methods, we searched the data through the databases, including PubMed/EmBase/CNKI/CQVIP/China Journals Full Text Database and websites and proceedings of major annual meetings such as ASCO and CSCO. The methodological quality of the included studies was assessed using the Jadad scoring system. Both English and Chinese publications were searched. We collected data from controlled clinical trials on CRT vs RT or CT for LAPC, and conducted a meta-analysis of 15 included studies. Meta-analysis was performed using RevMan4.2 Software according to the method recommended by Cochrane Collaboration.

RESULTS: Fifteen eligible randomized controlled trials including a total of 1128 patients were screened. Jadad score was 2 in only one article, and 3-4 in the remaining 14 studies. The meta-analysis showed that CRT was superior in the 6- and 12-mo survivals to the RT alone group or CT alone group (P = 0.0001 and P = 0.02, respectively), whereas the 18-mo survival showed no significant difference (P = 0.23). Subgroup analysis showed that the 6-, 12-, and 18-mo survivals were not significantly different between the CRT group and CT group (P = 0.07, P = 0.23, and P = 0.91, respectively). Notably, the CRT group had significantly better 6-, 12-, and 18-mo survivals than the RT group (all P < 0.01). CRT group had significantly more grade 3-4 treatment-related hematologic and non-hematologic toxicities than the CT group or RT group (all P < 0.01).

CONCLUSION: Compared with CT or RT, CRT can benefit the long-term survival of LAPC patients, although it may also increase treatment-related toxicities.

Keywords: Pancreatic cancer, Chemotherapy, Radiotherapy, Meta-analysis, Survival

Core tip: To compare the long-term clinical efficacy of chemotherapy plus radiotherapy (CRT) with that of radiotherapy alone (RT) or chemotherapy alone (CT) for locally advanced pancreatic carcinoma (LAPC)，the authors analyzed the potential impact of CRT, CT or RT on the survival of the patients using meta-analysis methodologies. Meta-analysis showed that compared with CT or RT, CRT can benefit the long-term survival of LAPC patients, although it may also increase treatment-related toxicities.